PAGES 1 AND 2 OF THIS DOCUMENT MUST BE MAILED TO THE CLAIMS CENTER.
OFFICIAL USE ONLY
ONLINE ONLINE ONLINE ONLINE INSTANT INSTANT INSTANT INSTANT PRIZE AMOUNT
Columbia Claims Center 1309 Assembly Street Columbia, SC 29201 Phone: (803) 253-4004 8:30 a.m. - 5:00 p.m. (M-F) (EXCEPT CERTAIN STATE HOLIDAYS) Players should arrive by 4 p.m. to allow time to verify winning ticket(s). Claims in excess of $500 must include: (1) this form and (2) a copy of an identi cation card (driver’s license, passport, military, or state I.D.) that includes a photo and date of birth.
OFFICIAL USE ONLY
(Driver’s License, Passport, Military, or State I.D.)
TYPE OF I.D.:
AUTHORIZED SIGNATURE: OFFICIAL’S NAME: (Please Print) CLAIM NUMBER PROVIDED BY S.C. EDUCATION LOTTERY DATE -
INSTRUCTIONS: 1. Complete the form on the reverse side entirely. Use one character per box. 2. Sign and date the reverse side of this form. 3. Sign and attach the Winning Ticket(s) to this form. Mailing Address: S.C. Education Lottery P.O. Box 11039 Columbia, SC 29211-1039 The risk of mailing ticket(s) remains with the claimant. Winnings greater than $100,000 must be redeemed in person at the Columbia Claims Center.
NAME Mr. Ms. MAILING ADDRESS CITY STATE DATE OF BIRTH ZIP
CLAIMANT-COMPLETE THIS SECTION
PHONE TAX STATUS
U.S. CITIZEN OR RESIDENT ALIEN SOCIAL SECURITY NO. NOT U.S. CITIZEN; NOT RESIDENT ALIEN. Country of citizenship must be provided below. You do not have to be a U.S. Citizen to claim a prize; however, YOU MUST indicate status for tax purposes.
Knowingly presenting a counterfeit, altered, or stolen lottery ticket or knowingly ling a claim based on facts that are untrue is in violation of South Carolina Law. Debts owed to South Carolina or its political subdivisions may be deducted from winnings. Multiple tickets presented at the same time will be combined. If the total winnings exceed $500,...
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